American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis.

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection.

The Importance of Medical Laboratory Scientists and the Number of Doctoral Scientists that Began Their Career by Working on the Front Lines of Laboratory Medicine.

Background: Due to dwindling numbers of medical laboratory scientists (MLS), we are faced with staffing issues due to lack of visibility, recognition, low wages, and perceived lack of opportunities for upward career mobility. A brief survey of doctoral-level clinical microbiologists showed a significant number were certified, worked "the bench," and used this experience as a steppingstone to become a laboratory director or consultant.

Objectives: To help dispel the notion working as an MLS is a dead-end job, the authors developed an expanded national survey.

A Literature Review on How We Can Address Medical Laboratory Scientist Staffing Shortages.

Objective: Laboratories are facing a critical shortage of medical laboratory scientists (MLS) and medical laboratory technicians (MLT) to address an increasing demand for laboratory testing. Training program closures, fewer student applicants, and financial decisions have contributed to staffing shortages. Lack of visibility, low wages, and perceived lack of opportunities for upward career mobility contribute to challenges in recruiting and retaining qualified individuals and students who are unaware of laboratory medicine careers.

Reducing Blood Culture Contamination Rates: Experiences of Four Hospital Systems.

Introduction: Blood cultures (BCs) frequently become contaminated during the pre-analytic phase of collection leading to downstream ramifications. We present a summary of performance improvement (PI) interventions provided by four hospital systems and common factors that contributed to decreased blood culture contamination (BCC) rates.

Methods: Each hospital independently formed a multidisciplinary team and action plan for implementation of their intervention, focusing on the use of educational and training tools.

A multi-laboratory comparison of two molecular methods for the detection of toxigenic Clostridium difficile.

Introduction: Diarrheal disease due to toxigenic Clostridium difficile (CD) accounts for an increased number of hospitalizations and deaths each year. Published guidelines recommend reflex testing of CD antigen-positive samples to molecular testing or testing samples directly by a molecular assay. This multicenter study was designed to compare the accuracy of two different molecular methods targeting different CD genes: Xpert C.

Infectious Endocarditis in 49-Year-Old Man and Discussion of Phenotypic Characteristics of Aerococcus urinae and Viridans Streptococci.

Patient: 49 year-old man.

Chief Complaint: Dyspnea at rest and dyspnea on exertion.

History Of Present Illness: Diagnosed with upper respiratory tract infection 10 days previously.

Respiratory virus identification by interval polymerase chain reaction testing in the southeastern United States.

Background: This study was designed to determine if testing the first ~40 nasal washings (interval) each month for 1 year, could be used as an epidemiologic tool for seasonality and prevalence of respiratory viruses such as human metapneumovirus in an adult and pediatric population in the southeastern United States.

Materials And Methods: Results of interval polymerase chain reaction (PCR) testing of 469 specimens for 8 viruses were compared with our current procedures using PCR, culture, or respiratory synctial virus antigen for all 7435 specimens (routine).

Results: One hundred thirty-six viruses out of 469 specimens (29.

Molecular epidemiology of carbapenem-nonsusceptible Acinetobacter baumannii in the United States.

Acinetobacter baumannii is emerging as an important nosocomial pathogen worldwide. We report molecular epidemiology of 65 carbapenem-nonsusceptible A. baumannii isolates identified from hospitals in New York, Pennsylvania, Florida, Missouri, Nevada, and California between 2008 and 2009.

Recombinant Adenovirus (AdV) Type 3 and Type 14 Isolated From a Fatal Case of Pneumonia.

We report a fatal case of pneumonia apparently due to adenovirus infection in a 53-year-old male who had recently returned from Iraq. The isolate was identified by sequence analysis as AdV3 and AdV14. Based on restriction analysis (REA), the virus appeared to be a recombinant virus containing properties of both AdV3 and AdV14 rather than a coinfection with these two viruses.

Klebsiella pneumoniae Carbapenemase-producing Enterobacteriaceae, Northeast Florida.

Background: Since 2001 there have been several reported outbreaks due to carbapenem-resistant Klebsiella pneumoniae (Kp), particularly in the northeastern states.

Methods: Carbapenemase-producing Enterobacteriaceae from healthcare facilities in Northeast Florida were phenotypically identified and confirmed using PCR amplification and sequencing of the blaKPC gene.

Results: Results from PFGE analysis of these isolates demonstrated possible horizontal spread from two possible "outbreak" strains during the study period.

Differences between ceftriaxone and cefotaxime: microbiological inconsistencies.

Objective: To review data to determine why pneumococcal isolates appear to be increasingly resistant to cefotaxime, historically regarded as having the same in vitro susceptibility to ceftriaxone, and what this observation might imply clinically.

Data Sources: Literature was accessed through MEDLINE (1966-October 2007) using the MeSH terms cefotaxime, ceftriaxone, susceptibility, microbial sensitivity tests, antibiotics, pneumococcal infections, Streptococcus pneumoniae, resistance, and cephalosporin resistance. Abstracts and surveillance databases were reviewed and unpublished data were provided by state departments of health and institutions.

Antimicrobial susceptibility among Acinetobacter calcoaceticus-baumannii complex and Enterobacteriaceae collected as part of the Tigecycline Evaluation and Surveillance Trial.

Objective: To measure the in vitro activity of a panel of antimicrobial agents against gram-negative pathogens collected from the nine census regions of the USA.

Methods: Isolates were collected from 76 centers between January 2004 and September 2005. In vitro activity was assessed using CLSI guidelines and CLSI or FDA interpretive criteria.

Clinical correlation of the CLSI susceptibility breakpoint for piperacillin- tazobactam against extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella species.

We assessed infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli or Klebsiella spp. treated with piperacillin-tazobactam to determine if the susceptibility breakpoint predicts outcome. Treatment was successful in 10 of 11 nonurinary infections from susceptible strains and in 2 of 6 infections with MICs of >16/4 mug/ml.

Continuous non-seasonal epidemic of respiratory syncytial virus infection in the southeast United States.

Background: This study was done to define the seasonality of respiratory syncytial virus (RSV) epidemics in the southeastern United States.

Methods: We tested 5,092 fresh nasal aspirates or washings, using the Kallestad Pathfinder enzyme immunoassay (EIA) or the Directigen RSV membrane EIA according to manufacturers' directions.

Results: A total of 1,419 (27.

Four-day incubation period for blood culture bottles processed with the Difco ESP blood culture system.

Blood culture records from 1994 to 1995 from five U.S. medical centers all using the Difco ESP continuous monitoring blood culture system were reviewed retrospectively.

Evaluation of two commercially available DNA tests for detection of human papillomavirus.

Objective: This study was designed to compare the sensitivity, specificity, efficiency, positive and negative predictive values, and ease of use for 2 commercially available hybridization kits for detecting human papillomavirus (HPV) DNA: Oncor Southern blot (SB) (Oncor, Inc., Gaithersburg, MD) and Digene ViraType dot blot (DB) (Digene Diagnostics, Inc., Silver Spring, MD).

Nosocomial herpes simplex virus infection associated with oral endotracheal intubation.

Background: To determine by culture the frequency of herpes simplex virus reactivation complicating oral endotracheal intubation. Additionally, clinical appearance and recognition of patient infection by attendant health care workers were studied. Last, evidence of any occupational acquisition of herpes simplex virus infection was sought.

Evaluation of five methods for respiratory syncytial virus detection.

A total of 117 nasal aspirates were cultured for respiratory syncytial virus (RSV) and tested for RSV antigen by a direct fluorescent-antibody (DFA) test (Bartels Immunodiagnostic Supplies, Inc., Bellevue, Wash.), the Directigen enzyme immunoassay (EIA; Becton Dickinson Microbiology Systems, Cockeysville, Md.

In vitro bactericidal activities of gentamicin, cefazolin, and imipenem in peritoneal dialysis fluids.

Continuous ambulatory peritoneal dialysis is an important modality of therapy for patients with renal disease. However, peritonitis continues to be a major risk factor and is usually treated by intraperitoneal administration of antimicrobial agents. Few data are available concerning the stability of antimicrobial agents in peritoneal dialysis solution beyond 48 h.

Evaluation of a rapid latex slide agglutination test for herpes simplex virus as a specimen screen and culture identification method.

A total of 449 clinical specimens and 199 culture fluids were tested using the Virogen Herpes Slide Test (Wampole Laboratories, Div. Carter-Wallace, Inc., Cranbury, N.

Comparison of the Ortho Cultureset (Vero cells) and Difco Cellmatics system (mink lung and primary rabbit kidney cells) for the detection of herpes simplex virus from clinical specimens.

Two Cellmatics (Difco) Herpes simplex virus (HSV) detection systems, one with mink lung cells (ML) and the other with primary rabbit kidney cells (PRK) and the Cultureset (Ortho) system with Vero cells were compared for their ability to detect previously positive specimens. One hundred fifty patients specimens positive for HSV in either Vero or PRK cells prior to freezing at -70 degrees C were thawed once, diluted to 1:8, and inoculated in duplicate into each cell system. Positive cultures were detected using each kit's immunoperoxidase method.

Premarket evaluation of IDS RapID SS/u system for identification of urine isolates.

A total of 170 fresh clinical urine isolates were tested with a premarket configuration of the RapID SS/u system (Innovative Diagnostic Systems, Inc., Atlanta, Ga.), a qualitative micromethod for the identification of selected organisms commonly isolated from urine specimens.

Comparison of a latex agglutination test with five other methods for determining the presence of antibody against cytomegalovirus.

A latex agglutination test for determination of antibody against cytomegalovirus was compared with five other methods: a solid-phase fluorescent immunoassay, an indirect hemagglutination test, two solid-phase enzyme immunoassays, and an indirect fluorescent-antibody method, with sera collected from 210 random blood donors. Of the sera tested, 28% were positive for anti-cytomegalovirus by concordance of four or more methods. The latex agglutination test performed well, with a sensitivity of 100%, a specificity of 99%, and positive and negative predictive values of 97 and 100%, respectively.